| NPI | 1770862971 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: TX R0314) |
| Additional Taxonomies | 2083C0008X Preventive Medicine Clinical Informatics (Licence: TX R0314) |
| Enumeration Date | 2011-08-05 |
| Last Update Date | 2017-03-24 |